在过去二十年间,麻醉技术和手术技术的改进使肺部恶性肿瘤患者的手术死亡率大大降低,但术后并发症仍是主要问题。肺切除术后的常见并发症是肺部并发症[1],主要表现是低氧血症,尤其在肺功能减退的肺切除患者中发病率更高[2]。目前国内对低氧血症的诊断缺乏统一的诊断标准,一些作者采用Russell等[3]提出的标准,吸空气氧的情况下,患者动脉血氧饱和度(SpO2)≤92%,大于30 s就可诊断为术后低氧血症。也有作者建议[4]将一次或以上血气检查PaO2 lt;8 kPa或PaO2/FiO2 lt;300 mm Hg(1 mm Hg=0.133 kPa)作为诊断低氧血症的标准。30%~50%的术后患者可发生低氧血症,一般认为这样的低氧血症是一过性的,对大多数患者是无害的[5]。但如果合并心脑或其他器官动脉硬化或其他原因的血管阻塞,这种低氧血症就是很危险的[6]。常见低氧血症的原因是肺萎陷不张和误吸、心源性肺水肿、静脉输入液体过量、通气血流比例失调和急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)[7],其中ALI/ARDS是肺切除术后患者死亡的主要原因[8-10]。
Citation: ZHANG Jing,XI Xiuming. Postpneumonectomy Hypoxemia. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(1): 69-73. doi: Copy
1. | Stéphan F,Boucheseiche S,Hollande J,et al.Pulmonary complications following lung resection:a comprehensive analysis of incidence and possible risk factors.Chest,2000,118:1263-1270. |
2. | 马刚,苏全冠,王欣,等.肺功能中度减退的肺癌患者术后并发症分析.癌症,2005,24:353-356. |
3. | Russell GB,Graybeal JM.Hypoxemic episodes of patients in a postanesthesia care unit.Chest,1993,104:899-903. |
4. | 刘颖珍,肖庆隆,徐波,等.胸部肿瘤病人围手术期血气监测及临床意义,中华胸心血管外科杂志,1994:10:220-222. |
5. | Hofer S,Plachky J,Fantl R,et al.Postoperative pulmonary complications:Prophylaxis after noncardiac surgery.Anaesthesist,2006,55:473-484. |
6. | Hedenstierna G.Alveolar collapse and closure of airways:regular effects of anaesthesia.Clin Physiol Funct Imaging,2003,23:123-129. |
7. | Shoemaker WC,Ayers SM,Grenvik A.重症监护学:第4版.北京:科学出版社,2001,1405-1408. |
8. | Myrdal G,Gustafsson G,Lambe M,et al.Outcome after lung cancer surgery.Factors predicting early mortality and major morbidity.Eur J Cardiothorac Surg,2001,20:694-699. |
9. | Ruffini E,Parola A,Papalia E,et al.Frequency and mortality of acute lung injury and acute respiratory distress syndrome after pulmonary resection for bronchogenic carcinoma.Eur J Cardiothorac Surg,2001,20:30-36. |
10. | Dulu A,Pastores SM,Park B,et al.Prevalence and mortality of acute lung injury and ARDS after lung resection.Chest,2006,130:73-78. |
11. | Iwamoto K,Ichiyama S,Shimokata K,Nakashima N,et al.Postoperative pneumonia in elderly patients:incidence and mortality in comparison with younger patients.Intern Med,1993,32:274-277. |
12. | Licker M,de Perrot M,Spiliopoulos A,et al.Risk factors for acute lung injury after thoracic surgery for lung cancer.Anesth Analg,2003,97:1558-1565. |
13. | Kutlu CA,Williams EA,Evans TW,et al.Acute lung injury and acute respiratory distress syndrome after pulmonary resection.Ann Thorac Surg,2000,69:376-380. |
14. | Holtz B,Bake B,Sixt R.Prediction of postoperative hypoxemia in smokers and non-smokers.Acta Anaesthesiol Scand,1979,23:411-418. |
15. | Dales RE,Dionne G,Leech JA,et al.Preoperative prediction of pulmonary complications following thoracic surgery.Chest,1993,104:155-159. |
16. | Arozullah AM,Khuri SF,Henderson WG.Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery.Ann Intern Med,2001,135:847-857. |
17. | 顾月清,廖美琳,周允中,等.肺功能与肺癌全肺切除术后近期预后的关系.中华胸心血管外科杂志,1995,11:214-216. |
18. | 王均玲,吴大玮,薛玉文.肺切除术前肺功能与术后并发症的关系探讨.山东医药,2005,45:10-11. |
19. | Filaire M,Bedu M,Naamee A,et al.Prediction of hypoxemia and mechanical ventilation after lung resection for cancer.Ann Thorac Surg,1999,67:1460-1465. |
20. | Parquin F,Marchal M,Mehiri S,et al.Post-pneumonectomy pulmonary edema:analysis and risk factors.Eur J Cardiothorac Surg,1996:929-932. |
21. | Hayes JP,Williams EA,Goldstraw P,et al.Lung injury in patients following thoracotomy.Thorax,1995,50:990-991. |
22. | Zeldin RA,Normandin D,Landtwing D,et al.Postpneumonectomy pulmonary edema.J Thorac Cardiovasc Surg,1984,87:359-365. |
23. | Lee E,Little AG,Hsu WH,et al.Effect of pneumonectomy on extravascular lung water in dogs.J Surg Res,1985,38:568-573. |
24. | Patel RL,Townsend ER,Fountain SW.Elective pneumonectomy:factors associated with morbidity and operative mortality.Ann Thorac Surg,1992,54:84-88. |
25. | Turnage WS,Lunn JJ.Postpneumonectomy pulmonary edema.A retrospective analysis of associated variables.Chest,1993,103:1646-1650. |
26. | Caras WE.Postpneumonectomy pulmonary edema:can it be predicted preoperatively?Chest,1998,114:928-931. |
27. | 周柏涛,邱树彬,徐小华,等.不同镇痛方法对老年病人开胸手术后并发症的影响.医学临床研究,2005,22:889-891. |
28. | Williams EA,Quinlan GJ,Anning PB,et al.Lung injury following pulmonary resection in the isolated,blood-perfused rat lung.Eur Respir J,1999,14:745-750. |
29. | Kim EA,Lee KS,Shim YM,et al.Radiographic and CT findings in complications following pulmonary resection.Radiographics,2002,22:67-86. |
30. | Jordan S,Mitchell JA,Quinlan GJ,et al.The pathogenesis of lung injury following pulmonary resection.Eur Respir J,2000,15:790-799. |
31. | Williams EA,Evans TW,Goldstraw P.Acute lung injury following lung resection:is one lung anaesthesia to blame?Thorax,1996,51:114-116. |
32. | Bauer P.Postpneumonectomy pulmonary oedema revisited.Eur Respir J,2000,15:629-630. |
33. | Kalweit G,Huwer H,Volkmer I,et al.Pulmonary embolism:a frequent cause of acute fatality after lung resection.Eur J Cardiothorac Surg,1996,10:242-246. |
34. | 应隽,王祥瑞.低氧性肺血管收缩与肺微循环.国外医学:麻醉学与复苏分册,2003,24:291-293. |
35. | 王祥瑞,主编.围手术期呼吸治疗学.北京:中国协和医科大学出版社,2002,248-258. |
36. | Kehlet H,Rosenberg J.Late post-operative hypoxaemia and organ dysfunction.Eur J Anaesthesiol Suppl,1995,10:31-34. |
37. | van der Werff YD,van der Houwen HK,Heijmans PJ,et al.Postpneumonectomy pulmonary edema.A retrospective analysis of incidence and possible risk factors.Chest,1997,111:1278-1284. |
38. | Bigatello LM,Allain R,Gaissert HA.Acute lung injury after pulmonary resection.Minerva Anestesiol,2004,70:159-166. |
39. | Detterbeck FC.Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy.Ann Thorac Surg,2005,80:1550-1559. |
40. | Hartrick CT.Multimodal postoperative pain management.Am J Health Syst Pharm,2004,61:S4-10. |
41. | 杭燕南,张马忠,徐萍,等.老年人围手术期低氧血症防治的研究.中华麻醉学杂志,1999,19:403-405. |
42. | 中华医学会重症医学分会.急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南.中国危重病急救医学,2006,18:706-710. |
43. | López-Herce J,de Lucas N,Carrillo A,et al.Surfactant treatment for acute respiratory distress syndrome.Arch Dis Child,1999,80:248-252. |
- 1. Stéphan F,Boucheseiche S,Hollande J,et al.Pulmonary complications following lung resection:a comprehensive analysis of incidence and possible risk factors.Chest,2000,118:1263-1270.
- 2. 马刚,苏全冠,王欣,等.肺功能中度减退的肺癌患者术后并发症分析.癌症,2005,24:353-356.
- 3. Russell GB,Graybeal JM.Hypoxemic episodes of patients in a postanesthesia care unit.Chest,1993,104:899-903.
- 4. 刘颖珍,肖庆隆,徐波,等.胸部肿瘤病人围手术期血气监测及临床意义,中华胸心血管外科杂志,1994:10:220-222.
- 5. Hofer S,Plachky J,Fantl R,et al.Postoperative pulmonary complications:Prophylaxis after noncardiac surgery.Anaesthesist,2006,55:473-484.
- 6. Hedenstierna G.Alveolar collapse and closure of airways:regular effects of anaesthesia.Clin Physiol Funct Imaging,2003,23:123-129.
- 7. Shoemaker WC,Ayers SM,Grenvik A.重症监护学:第4版.北京:科学出版社,2001,1405-1408.
- 8. Myrdal G,Gustafsson G,Lambe M,et al.Outcome after lung cancer surgery.Factors predicting early mortality and major morbidity.Eur J Cardiothorac Surg,2001,20:694-699.
- 9. Ruffini E,Parola A,Papalia E,et al.Frequency and mortality of acute lung injury and acute respiratory distress syndrome after pulmonary resection for bronchogenic carcinoma.Eur J Cardiothorac Surg,2001,20:30-36.
- 10. Dulu A,Pastores SM,Park B,et al.Prevalence and mortality of acute lung injury and ARDS after lung resection.Chest,2006,130:73-78.
- 11. Iwamoto K,Ichiyama S,Shimokata K,Nakashima N,et al.Postoperative pneumonia in elderly patients:incidence and mortality in comparison with younger patients.Intern Med,1993,32:274-277.
- 12. Licker M,de Perrot M,Spiliopoulos A,et al.Risk factors for acute lung injury after thoracic surgery for lung cancer.Anesth Analg,2003,97:1558-1565.
- 13. Kutlu CA,Williams EA,Evans TW,et al.Acute lung injury and acute respiratory distress syndrome after pulmonary resection.Ann Thorac Surg,2000,69:376-380.
- 14. Holtz B,Bake B,Sixt R.Prediction of postoperative hypoxemia in smokers and non-smokers.Acta Anaesthesiol Scand,1979,23:411-418.
- 15. Dales RE,Dionne G,Leech JA,et al.Preoperative prediction of pulmonary complications following thoracic surgery.Chest,1993,104:155-159.
- 16. Arozullah AM,Khuri SF,Henderson WG.Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery.Ann Intern Med,2001,135:847-857.
- 17. 顾月清,廖美琳,周允中,等.肺功能与肺癌全肺切除术后近期预后的关系.中华胸心血管外科杂志,1995,11:214-216.
- 18. 王均玲,吴大玮,薛玉文.肺切除术前肺功能与术后并发症的关系探讨.山东医药,2005,45:10-11.
- 19. Filaire M,Bedu M,Naamee A,et al.Prediction of hypoxemia and mechanical ventilation after lung resection for cancer.Ann Thorac Surg,1999,67:1460-1465.
- 20. Parquin F,Marchal M,Mehiri S,et al.Post-pneumonectomy pulmonary edema:analysis and risk factors.Eur J Cardiothorac Surg,1996:929-932.
- 21. Hayes JP,Williams EA,Goldstraw P,et al.Lung injury in patients following thoracotomy.Thorax,1995,50:990-991.
- 22. Zeldin RA,Normandin D,Landtwing D,et al.Postpneumonectomy pulmonary edema.J Thorac Cardiovasc Surg,1984,87:359-365.
- 23. Lee E,Little AG,Hsu WH,et al.Effect of pneumonectomy on extravascular lung water in dogs.J Surg Res,1985,38:568-573.
- 24. Patel RL,Townsend ER,Fountain SW.Elective pneumonectomy:factors associated with morbidity and operative mortality.Ann Thorac Surg,1992,54:84-88.
- 25. Turnage WS,Lunn JJ.Postpneumonectomy pulmonary edema.A retrospective analysis of associated variables.Chest,1993,103:1646-1650.
- 26. Caras WE.Postpneumonectomy pulmonary edema:can it be predicted preoperatively?Chest,1998,114:928-931.
- 27. 周柏涛,邱树彬,徐小华,等.不同镇痛方法对老年病人开胸手术后并发症的影响.医学临床研究,2005,22:889-891.
- 28. Williams EA,Quinlan GJ,Anning PB,et al.Lung injury following pulmonary resection in the isolated,blood-perfused rat lung.Eur Respir J,1999,14:745-750.
- 29. Kim EA,Lee KS,Shim YM,et al.Radiographic and CT findings in complications following pulmonary resection.Radiographics,2002,22:67-86.
- 30. Jordan S,Mitchell JA,Quinlan GJ,et al.The pathogenesis of lung injury following pulmonary resection.Eur Respir J,2000,15:790-799.
- 31. Williams EA,Evans TW,Goldstraw P.Acute lung injury following lung resection:is one lung anaesthesia to blame?Thorax,1996,51:114-116.
- 32. Bauer P.Postpneumonectomy pulmonary oedema revisited.Eur Respir J,2000,15:629-630.
- 33. Kalweit G,Huwer H,Volkmer I,et al.Pulmonary embolism:a frequent cause of acute fatality after lung resection.Eur J Cardiothorac Surg,1996,10:242-246.
- 34. 应隽,王祥瑞.低氧性肺血管收缩与肺微循环.国外医学:麻醉学与复苏分册,2003,24:291-293.
- 35. 王祥瑞,主编.围手术期呼吸治疗学.北京:中国协和医科大学出版社,2002,248-258.
- 36. Kehlet H,Rosenberg J.Late post-operative hypoxaemia and organ dysfunction.Eur J Anaesthesiol Suppl,1995,10:31-34.
- 37. van der Werff YD,van der Houwen HK,Heijmans PJ,et al.Postpneumonectomy pulmonary edema.A retrospective analysis of incidence and possible risk factors.Chest,1997,111:1278-1284.
- 38. Bigatello LM,Allain R,Gaissert HA.Acute lung injury after pulmonary resection.Minerva Anestesiol,2004,70:159-166.
- 39. Detterbeck FC.Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy.Ann Thorac Surg,2005,80:1550-1559.
- 40. Hartrick CT.Multimodal postoperative pain management.Am J Health Syst Pharm,2004,61:S4-10.
- 41. 杭燕南,张马忠,徐萍,等.老年人围手术期低氧血症防治的研究.中华麻醉学杂志,1999,19:403-405.
- 42. 中华医学会重症医学分会.急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南.中国危重病急救医学,2006,18:706-710.
- 43. López-Herce J,de Lucas N,Carrillo A,et al.Surfactant treatment for acute respiratory distress syndrome.Arch Dis Child,1999,80:248-252.